PMS & PMDD Explained: Root Causes, Hormones, and Holistic Treatment Options | Episode 20

In this episode of The Hormone Café, Dr. Sarah Pederson, holistic OB-GYN at Vera Health and Fertility, dives deep into PMS (premenstrual syndrome) and PMDD (premenstrual dysphoric disorder). She explains why PMS is not normal, explores the root causes behind luteal-phase mood and physical symptoms, and outlines a comprehensive, holistic framework for treatment — from nutrition and lifestyle to supplements, hormone testing, and medical therapies. In This Episode, You’ll Learn: 💡 What PMS and PMDD Actually Are PMS occurs during the luteal phase (after ovulation, before your period) Common symptoms: irritability, rage, mood swings, headaches, cramps, breast tenderness PMDD is a more severe form with debilitating mood symptoms that impair daily functioning PMS should not be normalized — symptoms almost always indicate an underlying imbalance 🩺 Root Causes of PMS & PMDD Blood sugar instability (increased insulin resistance during the luteal phase) Inflammation Hormonal imbalances (estrogen, progesterone, LH, FSH) Poor-quality or absent ovulation Gut and detox pathway dysfunction Chronic stress and elevated cortisol 🍽️ How to Eat During the Luteal Phase Your body needs more calories, rest, and nutrients after ovulation Aim for a 1:1 ratio of protein to carbohydrates Increase carbohydrates, but choose high-quality sources: Seed breads Protein pastas Brown rice and wild rice Always pair carbohydrates with protein Avoid large amounts of sugar, which fuel inflammation and worsen mood symptoms 🥑 Anti-Inflammatory Foods That Reduce PMS Symptoms Omega-3–rich foods: Fish (2–3x/week) Chia seeds Flax seeds Leafy greens for antioxidants: Kale Arugula Spinach Turmeric for inflammation reduction (cook with it or add to drinks) 🧠 Why Blood Sugar Matters for Mood Blood sugar spikes increase inflammation Inflammation disrupts neurotransmitters in the brain This directly worsens irritability, rage, anxiety, and depression in the luteal phase Continuous glucose monitoring can be helpful during this phase 🧪 Hormone Testing for PMS & PMDD Test hormones during the luteal phase (typically ~7 days after ovulation) Check: Estrogen Progesterone LH and FSH Consider testing on your worst symptom day if symptoms spike just before your period Mapping hormone patterns helps identify crashes, imbalances, and estrogen dominance ⚖️ Common Hormone Imbalances Linked to PMS Low progesterone High estrogen (estrogen dominance) Rapid estrogen drops before menstruation Anovulation (periods without ovulation) 🌿 Supplements Used for PMS & PMDD (Based on Labs) Vitex (chasteberry) to support hormone production Omega-3s (~1,000 mg daily if not eating enough fish) Magnesium for mood and muscle relaxation L-theanine and GABA for mood and anxiety support (taken at night) Adaptogens for stress-related PMS: Ashwagandha Rhodiola DIM or calcium d-glucarate for estrogen metabolism (only if estrogen is high) ⚠️ Important Note on Supplements  Supplements should always be chosen based on your specific hormone profile.  Do not take estrogen-lowering supplements if estrogen is already low. 💊 Medical Treatment Options (When Needed) Bioidentical progesterone during the luteal phase for low progesterone Bioidentical estradiol for estrogen crashes or severe luteal symptoms “Bridge dosing” to prevent sudden hormone drops before your period SSRIs/SNRIs (e.g., sertraline/Zoloft): Can be used as needed or only during the luteal phase Do not require daily, long-term use in many cases 🏃 Lifestyle Factors That Matter in the Luteal Phase Adequate calories and protein to support hormone production Exercise to help metabolize hormones (can tolerate higher intensity if well-fueled) Daily bowel movements to support estrogen detoxification Stress reduction to lower cortisol and improve mood regulation 🧬 Real Patient Case Highlight  A patient with severe rage and PMS symptoms was found to be: Not ovulating Estrogen dominant Insulin resistant After blood sugar regulation, cyclic progesterone, and nutrition changes, she resumed ovulation, normalized her luteal phase, and felt like herself again. Key Takeaways: PMS and PMDD are not normal and should not be dismissed. Luteal-phase symptoms are signals of deeper hormonal, metabolic, or inflammatory issues. Targeted nutrition, hormone testing, supplements, and — when needed — medical therapy can dramatically improve symptoms. Feeling amazing every day is possible with the right support. Resources & Next Steps: If you experience PMS, PMDD, migraines, mood swings, or luteal-phase discomfort, schedule a consultation with Dr. Sarah and her team. They take a root-cause, personalized approach to hormone health. 📍 Westminster, Colorado 🌐 Schedule a consultation: verafertility.com 📧 Follow along: @verafertility on Instagram & TikTok